Despite its decline in recent years, coronary heart disease remains the UKs
single biggest killer. When someone suffers a heart attack on a mountainside
in the UK, they often need a search and rescue (SAR) helicopter to provide
them with timely emergency care and to transport them to a suitable hospital.
The early diagnosis of an ST-elevation myocardial infarction (STEMI) from a
12-lead electrocardiogram facilitates timely initiation of reperfusion therapy,
but obtaining one in the mountain rescue environment is challenging and
sometimes impossible.
Although primary percutaneous coronary intervention for STEMI patients is
the treatment of choice, facilitating it renders the SAR aircraft unavailable for
greater periods of time and requires the relevant, supporting infrastructure to
be in place. The SAR paramedic must assess the suitability, validity and usability
of clinical guidelines and pathways on a case-by-case basis, then integrate
them into the demands of each particular SAR mission. Although cardiac
rehabilitation has not traditionally been within the remit of the pre-hospital
clinician, responding to the psychological needs of the heart-attack victim in the
aircraft may be a significant determinant to their participation in rehabilitation
programmes.

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